Case Report: Acute acalculous cholecystitis due to Salmonella Typhi: a case of conservative treatment failure and review of the literature

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Background Acute acalculous cholecystitis (AAC) is an uncommon but potentially life-threatening inflammation of the gallbladder in the absence of gallstones, accounting for 5–10% of all cases of acute cholecystitis. While most cases occur in critically ill or postoperative patients, infectious etiologies—particularly Salmonella Typhi —are increasingly recognized. Typhoid-related AAC is well described in children from endemic regions but remains rare in adults, with limited evidence to guide management. Case presentation We report the case of a 67-year-old man presenting with fever, chills, and epigastric pain following a self-limited diarrheal illness. Laboratory findings showed marked leukocytosis, elevated transaminases, and hyper-bilirubinemia with mild pain in the right upper quadrant. Blood cultures showed an infection of Salmonella Typhi sensitive to ceftriaxone. Despite 72 h of targeted antibiotic therapy, the patient remained febrile with rising inflammatory markers. Laparoscopic cholecystectomy was performed, revealing a gangrenous, necrotic gallbladder. Histopathology confirmed AAC with wall necrosis and abscesses. The postoperative course was uneventful. Conclusion This case highlights the importance of recognizing Salmonella -associated AAC as a rare but severe complication of typhoid infection in adults. While initial conservative therapy is reasonable, persistent symptoms or lack of improvement after 48–72 h should prompt early surgical intervention to prevent gallbladder necrosis, perforation, and sepsis.

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